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Public awareness of Lassa fever in

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three rural communities of Nigeria
a b
Bankole Henry Oladeinde , Richard Omoregie & Ikponmwosa
c
Odia
a
Department of Medical Microbiology, College of Health Sciences,
Igbinedion University, Okada, Edo State, Nigeria
b
School of Medical Laboratory Sciences, University of Benin
Teaching Hospital, P.M.B 1111, Benin City, Edo State, Nigeria
c
Institute of Lassa Fever Research and Control, Irrua Specialist
Hospital, Irrua, Edo State, Nigeria
Published online: 16 Oct 2014.

To cite this article: Bankole Henry Oladeinde, Richard Omoregie & Ikponmwosa Odia (2015) Public
awareness of Lassa fever in three rural communities of Nigeria, International Journal of Health
Promotion and Education, 53:3, 128-135, DOI: 10.1080/14635240.2014.968288

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 International Journal of Health Promotion and Education, 2015
Vol. 53, No. 3, 128–135, http://dx.doi.org/10.1080/14635240.2014.968288

Public awareness of Lassa fever in three rural communities of Nigeria

Bankole Henry Oladeindea*, Richard Omoregieb1 and Ikponmwosa Odiac2
a
Department of Medical Microbiology, College of Health Sciences, Igbinedion University, Okada,
Edo State, Nigeria; bSchool of Medical Laboratory Sciences, University of Benin Teaching Hospital,
P.M.B 1111, Benin City, Edo State, Nigeria; cInstitute of Lassa Fever Research and Control, Irrua
Specialist Hospital, Irrua, Edo State, Nigeria
(Received 15 December 2013; accepted 18 September 2014)

Lassa fever is endemic in west Africa. Persons at greatest risk are those living in rural
areas with poor sanitary conditions and overcrowding. Against this background, this
study aimed at assessing public awareness of Lassa fever among residents of three rural
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communities in Edo State, Nigeria. A total of 380 persons resident in rural Okada,
Ogbese and Utese communities of Edo State, Nigeria were enrolled for this study. Age
range of participants was between 15 and 69 years. A structured questionnaire was
administered to all volunteer subjects to obtain relevant information. Irrespective of
community studied, a total of 28 (7.4%) participants reported to have heard of Lassa
fever. Male gender was associated with awareness of Lassa fever in all communities
surveyed. The television was the most popular source of Lassa fever awareness in all
communities studied. Among participants who reported to have heard of Lassa fever,
vehicles of transmission of disease mentioned included mosquito bites 9 (32.1%), dog
bites 7 (25%) and eating of rat-contaminated food 2 (7.1%). Sleeping under mosquito
bed nets and intake of herbal concoction were the principal mode of prevention of
Lassa fever reported by respondents. A total of 15 (53.4%) and 16 (57.1%) of persons
aware of Lassa fever had no idea of any vehicle of transmission and mode of prevention
of the disease, respectively. Grave misconceptions on mode of transmission and
prevention of Lassa fever were observed in all communities surveyed. Renewed effort
at enlightening residents of rural communities on causes, modes of transmission and
prevention of Lassa fever is advocated.
Keywords: Lassa fever; Mastomys natalensis; awareness; rural communities; Nigeria

Introduction
Lassa fever is an acute viral zoonotic illness endemic in west Africa. It was first isolated in
1969, from a missionary who was infected while working as a nurse at Jos Mission
Hospital in Jos, Nigeria (Bond et al. 2013); ever since, outbreaks of the disease have been
reported in several parts of Nigeria (Abduralhim 2002, Achinge, Kur, and Gyoh 2013).
Lassa fever is endemic in Nigeria with the prevalence of antibodies to the virus being
approximately 21% in the Nigerian population (Tomori et al. 1988). Lassa fever has been
reported in more than 23 of the 36 states of Nigeria, with Edo State being one of the most
affected states (Achinge, Kur, and Gyoh 2013). Lassa fever has also been noted in other
west African countries including Liberia, Sierra Leone, Guinea and Mali (Ogbu et al.
2007). Every year, there are 300,000 estimated cases of illness due to Lassa virus in
endemic areas with about 45,000 deaths recorded (Senior 2009).

*Corresponding author. Email: bamenzy@yahoo.com

q 2014 Institute of Health Promotion and Education

 International Journal of Health Promotion and Education 129

Lassa virus is transmitted through the droppings of the multimammate rat (Mastomys
natalensis), which serves as the reservoir host to the Lassa virus. The rats breed frequently
and are distributed widely throughout west, central and east Africa (Richmond and
Baglole 2003) and are predominately found in rural areas (McCormick 1987). Persons at
greatest risk are those living in rural areas, especially areas with overcrowding and poor
sanitation conditions (Ogbu et al. 2007). Importation of Lassa fever however, by travellers
into non-endemic regions, has also been documented (Johnson and Monath 1990).
Early diagnosis is critical to effective management of disease. Lassa fever is known to
presents with symptoms and signs indistinguishable from those of febrile illnesses such as
malaria and other viral haemorrhagic fevers (Ogbu et al. 2007, Richmond and Baglole
2003), which are prevalent in the tropics. Complete reliance on clinical diagnosis of
disease consequently may be misleading. Diagnosis should be based on a combination of
clinical manifestation, epidemiological data and results of laboratory findings (Ogbu et al.
2007). Sadly however, its diagnosis is often impeded in rural areas of developing countries
where facilities to identify the virus are evidently lacking. There are no diagnostic centres
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for Lassa fever in our study areas and indeed the entire Ovia north-east Local Government
Area of Edo State, Nigeria. Consequently, many people in this region may suffer
undiagnosed cases of Lassa fever. This no doubt has great implication for the health and
general wellbeing of the people as missed diagnosis of Lassa fever has been reported to
increase the risk of transmitting infection to other members of the community at large
(Achinge, Kur, and Gyoh 2013).
Accurate knowledge of mode of transmission and prevention of disease is pivotal to
effective Lassa fever control. Data on awareness and knowledge of Lassa fever among the
Nigerian people are scanty, years after the disease was first discovered in the country.
Person-to-person transmission of Lassa virus and ingestion of M. natalensis faecal
contaminated food products are major vehicles of contracting the disease. Reports indicate
that Lassa fever is endemic in some rural communities of Edo State Nigeria (Eze et al.
2010). Although no outbreak of Lassa fever has been officially reported in Okada
community and environs, inter-community migration of persons and farm produce in Edo
state, may serve as a medium of disease spread from endemic areas to areas of low
prevalence. Data on public awareness of Lassa fever in Nigeria is sparse. Against this
background, this study was conducted to assess Lassa fever awareness level of residents of
rural Okada, Ogbeses and Utese communities of Edo Stae, Nigeria.

Materials and methods

Study area
This study was conducted during the months of June to November 2012, in rural Ovia
north-east Local Government area of Edo State. Communities surveyed included Okada,
Ogbese and Utese. The local Government area has an estimated population of 155,344
persons (National Population Commission 2006). Okada is the headquarters of Ovia north-
east Local Government Area. Igbinedion University is located in Okada community. Most
of the residents of the communities under study are farmers and traders.

Study population
A total of 380 persons resident in rural communities under focus were enrolled for this
study. All participants were between the ages of 15 and 69 years. A structured
questionnaire was administered to all volunteer subjects. Students and staff of the
 130 B.H. Oladeinde et al.

Igbinedion University, and the Igbinedion University Teaching Hospital Okada were
exempted from this study. Informed consent was obtained from all participants after the
purpose of the study was carefully explained to them. In the case of persons less than
18 years, consent was obtained from their parents/guardians. This was sometimes done in
the native local dialect to aid understanding. The study was approved by the ethical
committee of Ovia north-east Local Government Area Council of Edo State, Nigeria.

Sample size determination

Sample size determination was done using the formula (N ¼ Z2 £ P (1 2 P)/D2) obtained
by Naing and his colleagues (Naing et al. 2006).
Lassa fever awareness level of 36% set from a previous Nigerian study (Asogun et al.
2010) was used for this estimation.
A sample size of 380 persons was obtained.
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Statistical analysis
The data obtained were analyzed using Chi square (x 2) test and odd ratio analysis using
the statistical software INSTATw (Graphpad software Inc., La Jolla, CA, USA).
An association was established between two variables when an OR value $ 1.00 was
obtained. Statistical significance was set at , 0.05.

Results
A total of 517 persons were approached for this study, but only 380 agreed to participate
representing a response rate of 73.5%. Of the 380 participants recruited 28 (7.4%) reported
to have heard of Lassa fever. Respondents in Okada community were significantly more
likely ( p ¼ 0.010) to be aware of Lassa fever than respondents from other two
communities. An association was found to exist between awareness of Lassa fever and
male gender in all communities studied. Within each community surveyed, age did not
significantly affect awareness of Lassa fever ( p . 0.05) (Table 1). The television was the
most popular source of Lassa fever awareness in all communities surveyed (Table 2).

Table 1. Awareness of Lassa fever among respondents.

Okada community Ogbese community Utese community

(n1 ¼ 158) (n2 ¼ 110) (n3 ¼ 112)
Characteristics N No aware (%) N No aware (%) N No aware (%) P-value
Heard of Lassa Fever 19 (12.0) 6 (5.5) 3 (2.6) 0.01
Gender
Male 67 11 (16.4) 36 6 (16.7) 31 3 (9.7) 0.645
Female 91 8 (8.8) 74 0 (0.0) 81 0 (0.0) 0.001
Age (years)
15 – 27 73 5 (6.8) 45 2 (4.4) 41 2 (4.9) 0.611
28 – 40 55 11 (20.0) 37 3 (8.1) 45 1 (2.2) 0.004
41 – 53 23 3 (13.0) 15 1 (6.6) 22 0 (0.0) 0.079
$ 54 7 0 (0.0) 13 0 (0.0) 4 0 (0.0) –
Notes: N – number of respondents. Okada community (male vs. female): OR ¼ 2.038; 95% CI 0.7710, 5.387;
P ¼ 0.215. Ogbese community (male vs. female): OR ¼ 31.754; 95% CI ¼ 1.734, 581.65; P ¼ 0.001. Utese
community (male vs. female): OR ¼ 20.018; 95% CI ¼ 1.002, 398.85; P ¼ 0.019. Okada community (age):
P ¼ 0.506; Ogbese community (age): P ¼ 0.745 Utese community (age): P ¼ 0.232.
 International Journal of Health Promotion and Education 131

Table 2. Source of Lassa fever awareness among respondents.

Okada community Ogbese community Utese community

(n1 ¼ 19) (n2 ¼ 6) (n3 ¼ 3)
No aware No aware No aware Total (n ¼ 28)
Characteristics (%) (%) (%) (%)
Source of Knowledge
Television 15 (78.9) 6 (100.0) 3 (100.0) 24 (85.7)
Hospital 3 (15.8) 0 (0.0) 0 (0.0) 3 (10.7)
Friends 2(10.5) 0 (0.0) 0 (0.0) 2 (7.1)

Among respondents who had heard of Lassa fever, vehicles of transmission of disease
reported included mosquito bites 9 (32.1%), dog bites 7 (25%) and eating of rat-
contaminated food 2 (7.1%). Sleeping under mosquito bed nets and intake of herbal
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concoctions were the principal mode of prevention of Lassa fever reported by respondents
aware of the disease. A total of 15 (53.4%) and 16 (57.1%) of persons aware of Lassa fever
had no idea of any vehicle of transmission and mode of prevention of the disease,
respectively (Table 3).

Discussion
Lassa fever is associated with increased mortality and morbidity. Persons at greatest risk
are those living in rural areas, with very poor sanitation conditions and overcrowding
(Ogbu et al. 2007). Inadequate and incorrect information regarding vehicles of
transmission and mode of prevention of a disease can promote its spread among any

Table 3. Knowledge of reservoir host, mode of spread, and prevention of Lassa fever among
respondents.
Okada Ogbese Utese
community community community
(n1 ¼ 19) (n2 ¼ 6) (n3 ¼ 3)
Total
No aware No aware No aware (n ¼ 28)
Characteristics (%) (%) (%) (%)
Reservoir Host
Rat 2 (10.5) 0 (0.0) 0 (0.0) 2 (7.1)
Mosquitoes 12 (63.2) 5 (83.3) 2 (66.6) 19 (67.8)
Dog 6 (31.5) 1 (16.7) 1 (33.3) 8 (20.7)
Don’t Know 2 (10.5) 0 (0.0) 0 (0.0) 2 (7.1)
Mode of Spread
Eating of rodent-contaminated food 2 (10.5) 0 (0.0) 0 (0.0) 2 (7.1)
Mosquito bites 5 (26.3) 3 (50.0) 1 (33.3) 9 (32.1)
Dog bites 3 (15.8) 0 (0.0) 0 (0.0) 3 (10.7)
Had no idea 10 (52.6) 3 (50.0) 2 (66.7) 15 (53.4)
Mode of prevention
Keeping of foodstuff covered 2 (10.5) 0 (0.0) 0 (0.0) 2 (7.1)
Sleeping under mosquito nets 3 (15.8) 2 (33.3) 0 (0.0) 5 (17.8)
Drinking of herbal concoction 2 (10.5) 2 (33.3) 1 (33.3) 5 (17.8)
Had no idea 12 (63.2) 2 (33.3) 2 (66.7) 16 (57.1)
 132 B.H. Oladeinde et al.

people. Against this background, this study aimed at assessing the level of Lassa fever
awareness among residents of three rural communities of Edo State, Nigeria.
Irrespective of community studied, a total of 28 (7.4%) of all 380 participants enrolled
reported to have heard of Lassa fever. This is lower than 36% recorded in another Nigerian
study (Asogun et al. 2010). The study by Asogun and his colleagues (Asogun et al. 2010)
was conducted in a community close to the only Lassa fever diagnostic centre (The Irrua
Specialist Teaching Hospital, Irrua Edo State) in mid-western Nigeria. It is also important
to note that the study by Asogun et al. (2010) was also conducted in a community
previously reported to be ravaged by Lassa fever in Nigeria (Eze et al. 2010) in contrast to
our study area where no formal report of Lassa fever has been documented probably due to
poor surveillance. This may account for the difference in level of awareness of Lassa fever
in both studies. Massive inter-border traffic of persons has led to spread of Lassa fever
from endemic to non-endemic regions of Sub-Saharan Africa (Ogbu et al. 2007).
Ignorance of the existence of a disease has the capacity to fuel its spread. In this study, less
than 1 in every 10 persons claimed to be aware of Lassa fever. Such poor level of public
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awareness of Lassa fever may promote the spread of the disease in any community where
it exists.
Report from a previous Nigerian study revealed that about 5.9% of members of the
public that had contact with Lassa fever-infected patients were diagnosed of the disease in
Nigeria (Eze et al. 2010). Activities such as inter-communal trade, which is common in
rural areas of Nigeria, may promote the contact of Lassa fever-infected persons with
unsuspecting traders who may then serve as vehicles of transportation of the disease to
their respective communities. Exposure to Lassa virus may occur through agricultural
practices and mining (Abduralhim 2002). Inhabitants of Okada community and environs
are largely farmers, and may therefore engage in practices that have the capacity to
dislodge Lassa virus carriers (M. natalensis) from their natural habitat into human
settlements, thereby constituting a health hazard to residents of the community. This
underlines the need for vigorous Lassa fever health education program among the people.
Okada community plays host to the Igbinedion University, Nigeria’s premier private
University. The Igbinedion University Teaching Hospital and the administrative seat of
the Ovia north-east Local Government Area are also located in Okada community.
Participants in Okada community are therefore much more likely to engage in formal and/
or informal interaction with the academic community and other medical personnel at the
hospital than those in much more distant Ogbese and Utese communities. This may be
responsible for the finding of greater Lassa fever awareness observed among Okada
community residents.
The finding that males were significantly more aware of Lassa fever than females in
Ogbese and Utese communities may be connected with the fact that most rural women,
especially in Sub-Saharan Africa have limited financial and cultural autonomy, which
represents a barrier to access to health information. Awareness of Lassa fever did not
significantly differ with respect to age in all communities surveyed. In all communities,
the television was reported as the most popular source of Lassa fever awareness. Indeed
among residents of Ogbese and Utese communities, it was the only source of knowledge of
the disease.
Only 2 (7.1%) of participants aware of the disease identified rats as reservoir host for
the virus. This is in contrast to 51% who identified rats as source of Lassa fever infection in
a previous Nigerian study (Asogun et al. 2010). Over half 19 (67.8%) of the 28 persons
aware of Lassa fever reported mosquitoes as reservoir host for Lassa virus. Such grave
misconception as regards carrier agent of Lassa virus seems to suggest that majority of
 International Journal of Health Promotion and Education 133
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Figure 1. Showing States in Nigeria.

Figure 2. Showing the 18 Local Government Areas in Edo State. Key: D Okada Community; A –
Ogbese Community; O – Utese Community.
 134 B.H. Oladeinde et al.

participants, who claimed to be aware of Lassa fever in this study, may indeed be
completely ignorant of the disease and may have confused malaria fever for Lassa fever in
their minds when responding to the questionnaire. This suspicion was further fuelled by
the finding that 9 (64.3%) persons of the 14 participants who attempted to give a mode of
spread of disease reported mosquito bites as a vehicle for transmission. Again participants
aware of Lassa fever who reported use of mosquito nets and herbal concoction as
preventive tools for Lassa fever were in the highest proportion. Although the television
was reported as the most popular source of Lassa fever awareness, its impact on general
knowledge of Lassa fever was poor judging from responses from participants of this study.
Another study conducted in rural Nigeria on effectiveness of communicating HIV/AIDS
control measures through the television showed very little improvement in pre- and post
knowledge of HIV/AIDS among study participants (Odoemelam and Nwachukwu 2011).
Television-based information dissemination of health issues in Nigeria is often done in
English language. Most persons in communities under study are peasant farmers and may
not understand English language properly. This may result in impaired understanding of
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general knowledge of mode of spread and prevention of Lassa fever passed through such
channel as the television (Figures 1 and 2)

Conclusions
In all communities surveyed, awareness of Lassa fever was poor, as was knowledge of
mode of transmission and prevention of disease. Inadequate and incorrect information
regarding vehicles of transmission and mode of prevention of a disease can promote its
spread among any people. There is therefore urgent need for increased intervention effort
by relevant agencies at educating rural dwellers on causes, mode of transmission and
prevention of Lassa fever in Nigeria, with emphasis on the use of local dialect to facilitate
understanding.

Acknowledgements
The authors acknowledge with thanks all the participants in this study.

Conflict of interest
Authors have no conflict of interest to declare.

Notes
1. Email: richyomos@yahoo.com
2. Email: ikodia@rocketmail.com

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